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The Hungarian twist – a modified technique for an old problem
e116
Poster presentations / British Journal of Oral and Maxillofacial Surgery 51 (2013) e107–e129
Conflict of interest: Authors report no conflict of interests. http://dx.doi.org/10.1016/j.bjoms.2013.05.106
P25 The Hungarian twist – a modified technique for an old problem
P24
Syedda Abbas ∗ , Anna Fekete, John Reidy, Christopher Bridle, Michael Millwaters
Exodontia daycase venous thromboembolism prevention: from local audit to national change
Bartshealth NHS Trust, United Kingdom
M. Kerry Herd ∗ , J. Scott, V. Shekar, P.A. Brennan, R. Anand Queen Alexandra Hospital, Portsmouth, United Kingdom Introduction: NICE guideline 92 indicates gold standard venous thromboembolism (VTE) prevention for all hospital patients, without differentiating daycase surgery and inpatients. Our hospital protocol mirrors most in the UK dictating all patients are formally assessed preoperatively. We conducted a study to reveal guideline compliance for maxillofacial daycase patients, and challenged the appropriateness of these assessments locally and nationally to prompt policy change. Methods: All patients attending for general anaesthetic exodontia operations of less than 90 min were audited for six weeks. We recorded VTE risk factors and subsequent compliance with chemical or mechanical (TEDS) prophylaxis guidance. Results: 82 patients were audited, with 99% assessment compliance. “High risk” cohort comprised 45/82 (55%) patients indicating TEDS and chemo-prophylaxis. Contravening guidelines, in 44/45 (98%) chemo-prophylaxis was omitted; and in 38% (17/45) TEDS were omitted. “Low risk” cohort comprised 37/82 (45%) patients, not requiring prophylaxis. In 35/37 (95%) TEDS were inappropriately prescribed. No patients suffered VTE. Conclusions: Clinicians overlooked NICE guidelines with no adverse incident. Trust policy was revised, reclassifying all daycase exodontia patients as “low risk”. They no longer require thromboprophylaxis and are termed “cohorted”. Although patients may be considered for prophylaxis ad hoc, this new Department of Health terminology describes specific patient categories deemed so low risk as to not require routine assessment, liberating significant resources. For purely exodontia, we project a £3000 annual saving from inappropriate prescriptions, and a saving of 80 man-hours in administration. We feel this study illustrates and supports this new advice and would seek its national adoption. http://dx.doi.org/10.1016/j.bjoms.2013.05.107
Keratocystic Odontogenic Tumours, KOT, are unique cystic lesions derived from dental lamina cell rests or oral epithelium basal cell layer offshoots. Clinically, presentation varies, often mimicking other odontogenic-derived lesions. Definitive diagnosis is histological. KOT are characteristically locally aggressive with high propensity for recurrence and often multiple in Gorlin-Goltz syndrome. KOT are notoriously difficult to treat successfully. Literature reveals a range of techniques all aiming to eradicate the lesion and minimise recurrence and surgical morbidity. More conservative techniques include enucleation, decompression, marsupialisation and more aggressive methods, ostectomy, cryotherapy, carnoys application and resection (Stoelinga). Currently no consensus exists as to the most appropriate treatment. Methods: This modified decompression-tube technique, is currently employed in Hungary and combines established methods of a decompression-tube sutured to the cyst-cavity margin and a removable acrylic-obturator device. Conventional decompression of the cyst was performed; a tube was placed into and just protruding from the cyst-cavity and an impression taken with a medium-bodied silicone material. The cyst-cavity was packed with a whiteheads varnish pack. A soft rubber, custom-made, flanged decompressiontube device was constructed and subsequently fitted to the cyst cavity. Advantages of this technique are: ease of removal by the patient, aiding cleansing; the flange obviates the need for retention sutures; and ease of shortening the tube at regular intervals to allow healing. The authors recommend this method for use in the maxilla/mandible when cysts are large, multiple or close to important anatomical structures. We illustrate this novel technique with imaging and photographs from our small case series. http://dx.doi.org/10.1016/j.bjoms.2013.05.108
Poster presentations / British Journal of Oral and Maxillofacial Surgery 51 (2013) e107–e129
Conflict of interest: Authors report no conflict of interests. http://dx.doi.org/10.1016/j.bjoms.2013.05.106
P25 The Hungarian twist – a modified technique for an old problem
P24
Syedda Abbas ∗ , Anna Fekete, John Reidy, Christopher Bridle, Michael Millwaters
Exodontia daycase venous thromboembolism prevention: from local audit to national change
Bartshealth NHS Trust, United Kingdom
M. Kerry Herd ∗ , J. Scott, V. Shekar, P.A. Brennan, R. Anand Queen Alexandra Hospital, Portsmouth, United Kingdom Introduction: NICE guideline 92 indicates gold standard venous thromboembolism (VTE) prevention for all hospital patients, without differentiating daycase surgery and inpatients. Our hospital protocol mirrors most in the UK dictating all patients are formally assessed preoperatively. We conducted a study to reveal guideline compliance for maxillofacial daycase patients, and challenged the appropriateness of these assessments locally and nationally to prompt policy change. Methods: All patients attending for general anaesthetic exodontia operations of less than 90 min were audited for six weeks. We recorded VTE risk factors and subsequent compliance with chemical or mechanical (TEDS) prophylaxis guidance. Results: 82 patients were audited, with 99% assessment compliance. “High risk” cohort comprised 45/82 (55%) patients indicating TEDS and chemo-prophylaxis. Contravening guidelines, in 44/45 (98%) chemo-prophylaxis was omitted; and in 38% (17/45) TEDS were omitted. “Low risk” cohort comprised 37/82 (45%) patients, not requiring prophylaxis. In 35/37 (95%) TEDS were inappropriately prescribed. No patients suffered VTE. Conclusions: Clinicians overlooked NICE guidelines with no adverse incident. Trust policy was revised, reclassifying all daycase exodontia patients as “low risk”. They no longer require thromboprophylaxis and are termed “cohorted”. Although patients may be considered for prophylaxis ad hoc, this new Department of Health terminology describes specific patient categories deemed so low risk as to not require routine assessment, liberating significant resources. For purely exodontia, we project a £3000 annual saving from inappropriate prescriptions, and a saving of 80 man-hours in administration. We feel this study illustrates and supports this new advice and would seek its national adoption. http://dx.doi.org/10.1016/j.bjoms.2013.05.107
Keratocystic Odontogenic Tumours, KOT, are unique cystic lesions derived from dental lamina cell rests or oral epithelium basal cell layer offshoots. Clinically, presentation varies, often mimicking other odontogenic-derived lesions. Definitive diagnosis is histological. KOT are characteristically locally aggressive with high propensity for recurrence and often multiple in Gorlin-Goltz syndrome. KOT are notoriously difficult to treat successfully. Literature reveals a range of techniques all aiming to eradicate the lesion and minimise recurrence and surgical morbidity. More conservative techniques include enucleation, decompression, marsupialisation and more aggressive methods, ostectomy, cryotherapy, carnoys application and resection (Stoelinga). Currently no consensus exists as to the most appropriate treatment. Methods: This modified decompression-tube technique, is currently employed in Hungary and combines established methods of a decompression-tube sutured to the cyst-cavity margin and a removable acrylic-obturator device. Conventional decompression of the cyst was performed; a tube was placed into and just protruding from the cyst-cavity and an impression taken with a medium-bodied silicone material. The cyst-cavity was packed with a whiteheads varnish pack. A soft rubber, custom-made, flanged decompressiontube device was constructed and subsequently fitted to the cyst cavity. Advantages of this technique are: ease of removal by the patient, aiding cleansing; the flange obviates the need for retention sutures; and ease of shortening the tube at regular intervals to allow healing. The authors recommend this method for use in the maxilla/mandible when cysts are large, multiple or close to important anatomical structures. We illustrate this novel technique with imaging and photographs from our small case series. http://dx.doi.org/10.1016/j.bjoms.2013.05.108